01070068 CI BUI DING DIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERMIT NO.
22588 LAZY OAK CT SOUTH BAY REFRIGERATION 01070068
OWNER'S NAME: APPLICATION UB DATE
YOUNG RICHARD A 461 PERRYMONT 07/17/ 2001
PHONE: (408) 279-1911 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
W BLDG ELECT PLUMB MECH
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L i ___I I- 1 1=1
FF LICENSED CONTRACTOR'S DECLARATION
O O- I hcrtb flan Nal I ant licenced under fCha ter 9(commencin Job Description
°'-_° pr°vial°"'° p g INSTALL 36000 BTU CONDENSING UNIT.
pHF_� wits Section 1006)of 3.(,he Business and Pmfe;xr,C e,anyn imine
<Y Y J in^ull force and p�ci., / U S
mza. e< uClass_C�ytlt— Lis.» =@6�ge4BmE®
a°d ia`ate G°mr:rear
u 3 m ARCHITECT'S DECLARATI
s_eoo
1 understand my plans shall be used as public records
ce ce�' JUL 2 0
a aa S Cleansed Prnfeasio°a' 2001
OWNER-BUILDER exempt
DECLARATION
r=s Z I 1 hemby affirm that 1 am esemPt from the Contractor License law for the 3 B O O
a.Z I Inll°wlug mar°n.(Sculm.70.0.5,Ihniimsc mid l mmAinm Core:Any civ errenemy BUILDING
which requires a lermit m concnuca altar,improve,demolish,of repair any struuum
63,a.-prior to isissuance,also requires the applicant for.such permit to file a signed statement. --- - -
thatheislicensedpuauanttodepowkionsoftheContmctorsLicenselaw(Cha 9
momarmncingwith S<cdnn 7")ofDivision3oflhe Business and PofssionCode) . i„340.13 G , . - , , Valuation� {
or Nai he is alaar i therefrom marine basis for the ailegeU exemption.Any vic lainn
-of Section 7031.5 by any applicant for a permit mocas Ne applicant to a civil penalty
°fnotmcmthanfivenundomd°hars(s50o). 303Al?NAT92Ji MECHANIAL Occupancy Type
Dl.as owner flhe praiserry,or, my employees with wages as their sole compenmtion, 304 ROUGH ELECTRI AL
will nese a work,and Ne swnurrirn tr intended forLi or aofferedLaw for snot(sec.lou. 5 0 5 - FINAL ELfftggMR3 CAkctions '
Basi do t and work,
an ore Code:The Cont s License Law does not apply to 4 '
owner of property who builds or improves thereon,and who does such work himwlf 508 — FINAL MECHANI CAL
of Ned for sal own emosser,t provided that such improvements art not intended or
completion,
ion,the:wnerw wilder
the Wilding or iman ofpent n sold within one year of
opture for the owner W ilder will have the burden of paving that he did not Wild or
imprmve for purpose of sale.),
s owner of theproperty, elyc
❑i, am exclusivelycontractingwith Iicenmhc°mmcact to
camera the project(Sec.704a.Business and Professions Caleq The a,, ban—,
License Law d«s not apply on, net with
a contractions)
who) lids seimprove t to do
and who conuac¢.for.such projects with a can0anor(s7 licemed pursmm IB Ne .. .. .. _..._.
. .. � Convucmr's License law. .,,,,,
❑lam ecmpl under Seci B S P C for Into rea.on ' . .u. .. - -
_ Owner 'Date
WORKER'S COMPENSATION DECLARATION
_ l hereby affirm under penally of perjury,one of the following decimations.
❑ 1 have and will maintain a Cenibeae of Concent to sell Insure for Worker's
Compensation, as provided for by Section 3700 of he Labor Code. for the
performunle'of the xvrk for which His permit i.u'wed.
❑1 have and will maintain Worker's Compensation Insurunce,as required by Section
3700 of the Imthror Code for the pie fonnance of the forkjor which this permit is
issued W kC t Isur
once ca <rad icy umberarc:
C e CRTOIFICATIOFE%PollEMPI'IONIROM WO KERS( -5� . . ) ' };,ty¢ js 1}�,' . ._-\_ ; ,.__..�._..�„ •,,,.-•„
COMPENSATION INSURANCE—a
-. .'(This scaion nuij not..complFled if the permir is for.one hund
a.. ...
hundred - r "t C' •.. �. .:�� . , ,' U '.
(510(11 or less.),
icenifYthin in the perfnrmana of the work far which this permit is issued.1
,hall of amploy any p<rmn,in any manner'so as m become subject to the Workers '
Compensation Laws of Califomia.Data I
Applicant •I..•, .,
NOTICE TO APPLICANT,IL aper making this Certificateiof of Exemption,you should '
Q forthwith comply th such ons or Nis t shall he deemed resoled.you must
Z become suM1jecuolhe Workers Compmisation Provisions of the Whnr Cm
p y sus provisi -Griot okcd.
,y s "CONSTRUCTION LENDING AGENCY '
P,'? I hereby Rmt that there is o cor,tractian1, ling agency far the perforso ma
'. of the work for which this perm t is is.ued(Sec.3097,Civ.C.)
de
Q Lenr's Name - . . .. .. _. _ ... . .. .. _ .
= Z Lender's Address'" . . .... ..
U 1 certify that 1 have read this application and stale that the above information is
coact.I agree to comply with all city'rand county°Nimnces am sine laws relating
,Q U nM1uildin'conumc'on;and huraby auNoriae reprcoenmrives of this airy menmr upon
the zbovementio d Property for ins ci m pury0us.,
Ey d (Wel ag m cave,indamn' keep M1armlesr Ina City ul Cupcnine ugainu
liabilities,lad ne Is,cos and pe s which may in anY way ae<me against said
U Z C'oy in e e e rS Ing This permit. - -
APP". ,p ° EI ST. ,U A WILL COMPLY,WITH ALL NONPOINT' Issued b Dale
SOU
cE - LA Ks: Y
si arpt,camfOrInume,or Data Re-roofs �—
HAZARDOUS MATERIALS DISCLOSURE O d
Will the nppliam or fumrc Wilding occupant 3me or handle hovNous material Type of Roof �. . ........._,_,_-_
Municipal Code,Chapter 9.12,and the Health and Safety •'
❑Yes
os difined
canton
eNe,Section s, [],No ` ,,," All..roofsshall-be.inspected prior to.any,roofing material being installed. ._..-. _
Will th<applicam or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection;'I'agree to'remove
emit meridiem,air contaminants as defined by the Bay Area Air Quality Management
Dindct,! .. ID No all new materials for inspection. Applicant understands and.will comply with
Cl ye, all non-point source regulations.
I
hove.nod I b urdous materials n mens under Chapter 695 of be
California Health f y Cuda Sections 2505.!`5533 and 25534.1 umlerstandthat
Ifthc Wiwi rr6 urcndY hareu or I h His my...spansibilitY to notify the --- _ - -
«<upam t fi menfs whi Host e m prior to Issuuncc of a Ccnifinm of
' y: Signature of Applicant Date _
Owns,mahompd agent Data All roof coverings to be Class "B"or better „
OFFICE